腹腔高压致肾脏和全身微循环变化的实验研究

Experimental study on the changes of renal and systemic microcirculation induced by intra-ab- dominal hypertension

目的本研究试图评价不同腹腔高压对肾脏表面和全身微循环灌注的影响。方法将12只健康小香猪，采用CO2气腹法建立腹腔高压模型，腹腔压力自基线值逐步升高至10mmHg、15mmHg、20mmHg和25mmHg。在每个腹腔压力梯度下，留取全身血流动力学参数、尿量、舌下和肾脏表面旁流暗视野成像微循环监测（SDF）视频。结果随着腹压升高，尤其是当腹腔压力超过20mmHg，小猪舌下MFI明显下降。但其他参数如总血管密度（TVD）、DeBacker指数、血管灌流比例（PPV）、灌注血管密度（PVD）和异质性指数（HI）并没有改变。随着腹腔压力升高，肾脏表面SDF监测MFI下降约30％,肾脏表面MFI与APP呈中度相关（r=0．64，P〈0．05）。结论肾脏表面SDF能有效评估肾脏表面微循环灌注，而MFI是评价。肾脏表面微循环的有效指标。

Objective Intra-abdominal hypertension （IAH） and abdominal compartment syn- drome （ACS） are the common complications of patients in intensive care unit. When the intra-abdomi- nal pressure （IAP） is increased, the perfusion of abdominal organs is decreased, and this is one of the causes of acute kidney injury （AKI）. The purpose of the study is to evaluate the renal cortical and sublingual microcirculation by sidestream dark field （SDF） imaging in the porcine model. Methods In 12 pigs, lAP was increased stepwise to 10, 15, 20, 25 mm Hg while hemodynamic parameters, urinary out- put, sublingual and renal SDF videos pictures were all recorded. Results With the increase of abdominal pressure sublingual MFI drop significantly, especially when IAP was higher than 20 mm Hg. But other parameters such as the total vascular density （TVD）, De Backer Score, proportion of perfused vessels （PPV）, perfused vessel density （PVD）, and heterogeneity index （HI） of tongue were not changed. With increasing IAP, MFI decreased about 30%. APP showed a moderate correlation with MFI （r = 0.64, P 〈 0.05）. Conclusion SDF on surface of kidney is a useful tool to evaluate the microcirculation of kidney.